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Meta-Analysis
. 2020 Nov;48(11):300060520966478.
doi: 10.1177/0300060520966478.

Meta-analysis of postoperative antithrombotic therapy after left atrial appendage occlusion

Shu-Yue Li  1   2 , Juan Wang  3 , Xiang Hui  1   2 , Huai-Jun Zhu  1 , Bao-Yan Wang  1 , Hang Xu  1
Affiliations
Meta-Analysis

Meta-analysis of postoperative antithrombotic therapy after left atrial appendage occlusion

Shu-Yue Li et al. J Int Med Res. 2020 Nov.

Abstract

Objective: This meta-analysis explored the safety and effectiveness of different anticoagulant regimens after left atrial appendage occlusion (LAAO).

Methods: Databases, such as PubMed, MEDLINE, EMBASE, Web of Science, and Cochrane Library, were searched to identify eligible studies according to the inclusion criteria. The incidences of events, including device-related thrombus (DRT) formation, stroke, systemic thromboembolism, bleeding, cardiovascular mortality, and all-cause mortality, were analyzed using R version 3.2.3.

Results: The screening retrieved 32 studies, including 36 study groups and 4,474 patients. The incidence of outcomes after LAAO was calculated via meta-analysis. In the subgroup analysis, the rates of DRT formation, cardiovascular mortality, and all-cause mortality were significantly different among different antithrombotic methods. Single antiplatelet therapy was associated with the highest rate of adverse events, followed by dual antiplatelet therapy (DAPT). Vitamin K antagonists (VKAs) and new oral anticoagulants (NOACs) carried lower rates of adverse events.

Conclusions: Anticoagulant therapy had better safety and efficacy than antiplatelet therapy. Thus, for patients with nonabsolute anticoagulant contraindications, anticoagulant therapy rather than DAPT should be actively selected. NOACs displayed potential for further development, and these treatments might represent alternatives to VKAs in the future.

Keywords: Left atrial appendage occlusion; antiplatelet therapy; antithrombotic strategies; device-related thrombus; meta-analysis; oral anticoagulant; vitamin K antagonist.

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Conflict of interest statement

Declaration of conflicting interest: The authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
Screening flowchart.
Figure 2.
Figure 2.
Forest plot of efficacy outcomes. (a) forest plot of major DRT, (b) forest plot of systemic thromboembolism, (c) forest plot of stroke/TIA. CI, confidence interval; DRT, device-related thrombus; TIA, transient ischemic attack.
Figure 3.
Figure 3.
Forest plot of safety outcomes. (a) Forest plot of major bleeding, (b) forest plot of minor bleeding, (c) forest plot of cardiovascular mortality and (d) forest plot of all-cause mortality. CI, confidence interval.
Figure 4.
Figure 4.
Funnel plot of cardiovascular mortality.
See this image and copyright information in PMC

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